Book menuCONTRACEPTION - Full extract 

It is very important for men and boys to have a thorough understanding of contraception and the various choices that are available. Surprisingly, some people still regard contraception as something for the woman to worry about. Some people don't even give the matter a thought. These days any thinking male should regard contraception as a joint responsibility.  

Fortunately, many excellent methods of contraception are available. It is a matter discussing the available options and helping people decide what suits them best. There is so much discussion in the media that many people have already made a suitable choice before they see a doctor for advice. 

As well as practical considerations, the method chosen may be influenced by cultural or religious factors. What suits one couple might turn out to be hopeless for another. However, there are several aspects to consider... 

  • The age of the female partner and whether she has already had children. 
  • Previous experience with contraceptives. 
  • Whether there is one or more sexual partners. 
  • The frequency of intercourse, how often protection is required. 
  • The female partner's past medical history, such as whether there has ever been high blood pressure, blood clots in the legs, or menstrual problems like heavy or painful periods. 
  • Whether both or all parties are interested and cooperative. 
  • The possibility of acquiring sexually transmitted disease. 

Before a contraceptive pill is required the female partner should have a thorough medical assessment, including a blood pressure check, breast examination and a Pap smear, if this has not been done recently. Other aspects of sexual health may also need to be discussed, such as whether condoms should also be used. The main methods of contraception these days are: 

The oral contraceptive pill  A variety of types are available, all low dose compared to earlier formulations. Sometimes an adjustment in the strength or type is required. The standard combined oestrogen-plus- progesterone pills work mainly by switching off the ovulation process. Some of the newer types have slightly different progesterone components that may help conditions such as acne. Although the pill has a very good track record for safety and reliability it should always be taken under regular medical supervision. It is better to avoid the pill if there is a history of conditions such as high blood pressure, blood clots and severe migraine. It should also be kept in mind that smoking greatly increases any risks associated with the pill. 

If antibiotics are being taken, the pill can be less effective and other methods of contraception such as condoms should be used for at least seven days after finishing the antibiotics. Likewise, vomiting and diarrhoea can also reduce the pill's effectiveness. 

The pill may also be used as an emergency contraceptive after unprotected intercourse or a condom breakage. It must be taken within 72 hours and a special dose is required. Specific advice from the doctor is necessary. 

The mini-pill provides an alternative to the standard pill, and may be suitable for women who cannot use oestrogen. It is also recommended for breastfeeding mothers. It contains just low dose progesterone and, among other things, acts on the cervical mucus to make it impenetrable to sperm. Although the mini-pill does not stop ovulation, it is still very effective. Because of the very low dose, it should be taken at the same time each day. 

Barrier methods  have had a great resurgence in recent years. Concern about AIDS and other sexually transmitted diseases has seen condom sales go through the roof. Condoms are the basis of any advice about safer-sex. 

Some women find the diaphragm an excellent option. A fitting by the doctor is required first, to select the most suitable size. Spermicidal gel or cream should be used with any barrier method to improve its reliability. 

Intrauterine devices (IUD's)  are a good method for some women, especially for intervals between children, or while waiting to decide on a more permanent method. They are not suitable if periods are painful or heavy, or if there is any structural abnormality with the uterus. 

Natural methods of contraception  such as the ovulation method suit some couples, but are generally less dependable. Limitations with the interpretation of mucus signs, and the number of safe days for sex, mean couples need to be very well-motivated to make it work. 

The permanent methods  like laparoscopic sterilization for women and vasectomy for men are the absolute forms of contraception. A careful assessment and a clear explanation of the procedure is essential. Men require a sperm count six weeks after a vasectomy to check that the operation has been successful. Both procedures carry a low-risk and are very effective. Occasional concerns linking vasectomy with other medical problems have not been substantiated. 

Long-acting hormone injections  for the female partner are a less common method now approved for use in Australia. Each injection provides effective contraception for 12 weeks. A number of other methods are also being developed. 

Health Tip:
* Although there is no such thing as the perfect contraceptive, in most cases a very suitable method can be advised.


Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001